The objectives of this application are to introduce instruction in environmental and occupational medicine (EOM) to the medical school curriculum at Emory University, and to provide for its long-term viability. Like many medical schools regionally and nationally, Emory at present has almost no dedicated instruction in this field. Specific aims include: introducing EOM to students and residents and providing a visible, dynamic role model; encouraging attitudes including willingness to consider environmental and occupational causes of disease, orientation toward prevention, and sensitivity to special risk groups; training in skills including environmental and occupational history-taking, data collection, referrals, and risk communication; and imparting knowledge of major environmental and occupational diseases and exposures, sentinel pathophysiologic events, workers compensation and disability, key diagnostic tests, and preventive approaches. The plan begins with four efforts in the medical school's core curriculum: problem-based learning cases for use in the first and second year, introduction of extensive EOM in a new first-year course (community and analytic medicine), inclusion of EOM in the required third-year primary care clerkship, and case presentations in the third-year internal medicine rotation. Subsequent efforts include introducing further EOM instruction into other basic science and clinical courses, systematic review of available EOM instructional aids for consideration of adoption at Emory, and introducing teaching conferences and elective rotations in Emory's Internal Medicine residency. Two "freestanding" efforts are also proposed: a summer clerkship for medical students in EOM, and development of a joint residency combining Internal Medicine with Occupational and Environmental Medicine. These initiatives will be "extended" to nearby Morehouse School of Medicine. All results will be systematically evaluated with suitable methods. Philosophically this plan is based on "incorporation" instead of "competition." Rather than attempt to wedge a new course into an already crowded curriculum, or to modify drastically an existing course, the approach is to include EOM topics in existing courses. Several rationales are presented. The individual identified to lead these efforts at Emory is Howard Frumkin, M.D., Dr.P.H., Associate Professor and Director of the Division of Environmental and Occupational Health in the School of Public Health, Director of the Environmental and Occupational Medicine Program at the Emory Clinic, and Assistant Professor of Medicine in the School of Medicine.